Our aim is to study the psychometric properties of the HAD scale in Spanish cancer patients.

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vant endpoint also in psycho-oncological intervention
slUdies.
'fhe purpose of the current paper is to critically examine
Ihe contribution of quality of Jife research to assessing the
results of oncological treatment both in terms of cIassical
medical approaches as well as psychosocial approaches.
Coping modes and adaptivity in cancer palients
EdgarHeim
Ulliversity 01 Bern, Switzerland
It is generalIy assumed nowadays that coping ís best
explained as a transactional proeess. The potentiaI coping
repertoire are broad, eomplex and dynamic. Coping must
be understood in terms of differing and sometimes con-
tlicling goals. One stralegy to study coping and caneer is
to study its mediating effeet on the somatie proeess as the
primary slressor. In contrast the one here referred to un-
derstands the different psychosociaI demands as dependant
variables of the somatic course oe secondary stressors
with varying goals over time. Thus coping may be seen as
having a preventive, buffering or restoring effect on
psychosocial adaptation.
A survey of aH controlled studies available over the last
15 years will allow for sorne conclusions on appropriate
versus inappropriate coping in adaptation to caneer. In
successful or 'good' coping an active. tackling behaviour
by the patient combined with a supportive and responsive
environment is central. Realistic, problem-analysis com-
bined with aceepting conditions beyond one's control is
also important. In 'bad' or unfavourable coping resigna-
tion/fatalism, a repressive, denying attitude and social
withdrawal are predominant.
Effects of different relaxalion techniques on
particular aspects of quality of Iife (QoL) of female
breast cancer patients
S. Kresi, S. Moller, l. Florill', C. Vogele'
JDep. 01 Ps)'chology, Philipps-Universitiit
Marburg; )RehahilitationszeJJtrlllll Urbaclttal. Neukirchen,
Germany
This study was carried out to examine relaxation effects on
QoL of breast caneer patients during rehabilitation.
69 breast cancer patients were randomly assigned to auto~
genic training (An, progressive relaxation (PR) or mind
machine (MM). AH received six sessions of relaxation
training. Standardized questionnaires were used to opera-
tionalize QoL at four defined measurement points before
and after training. Analyses of variance were applied.
Throughout the whole examination period AT caused the
strongest amelioration, relaxation by MM a worsening of
eertain aspeets of eurrent physical well-being. Al the end
of the intervention and at the 4th point of measurement
participanls of active relaxalion leehniques (AT, PR)
evaluated differenl aspeets of their physical and psyeho-
logical well-being more positive than patients relaxing
by a MM. Betwecn terminadon of supervised sessions and
the end of this study a decrease in several areas of well-
being was observed in aU groups.
Relaxation techniques have positive short-term effects on
the QoL of breast caneer patients. Furthermore results
point to a differential indication. Active relaxation lech-
niques should be preferred due to their long-term effects.
Qualíty of the Iife (QoL) of elderly patients with
Hodgkin's Oisease (HO)
Nikita Schklovsky-Kordi, Marina Kalmykova, Marina
Ivaschkina
Dpt. 01 Haemotology and 11Ilensive care, National Celllre
lor Haemotology, Moscow, Russia
For QoL estimation health, socio-economic situation.
family circumstances, professional activity, personal
contacts and sorne other scaIes were measured together
with goaIs evaluation according the B. Ruppkin's methods
and adapted fonn of EüRTC - H8-LQ .
50 patients with HD (7 of them were more eIder than 55
years old), who had received treatment according to the
protocols MQPP - ABVD and Stanford during the years
1996 to 1997 (HO' pIS), and 25 healthy subjeets fmm
control group (CG) (7 of them were more elder than 55
years old) were inquired by Ruppkin's questionnaire and
EüRTC - H8-LQ.
Al! 7 eider HD' pts eslimaled thelr QoL as high, but only 2
subjeels fmm ca marked QoL as high, and 5 as middle. 1n
both the groups of elder subjects sphere of health Vas
most important. But in the groups of aduIt, but not old
healthy subjects family and professionaI sphere are most
important, but "health" Vas in the lasl place. Elderly 00'
pts are more salisfied by theje family, social, economic,
professional status eompared to the healthy ca of the
same age.
Que conclusion are: a) The satisfaetion of the Jife besides
elder HD' pIS Is higher lhan In CG of the same age; b) The
factor tlheaUh" is in the first place in both groups; c) In
the risk situation value motives, which are related with
other spheres of QoL and mark out the motive "health" as
main, are reduced.
Assessing anxiety and depression with HAO scale
in a Spanish cancer population: a preliminary
validation study
S. López-Roig, M. C. Tero/, M. C. Neipp, l. Leyda, B.
Massutfl, C. PicóJ, M. A. Pastor
Health Psychology Department, Faculty 01 Medicine,
U"iversity Mlguel Hernández. San Juan, Spaitl,'
JOncology Unit, Hospital General de Alicante, Spain
The Hospital Anxiety and Oepression Seale (HAO) is
being used increasingly with patients as an instrument to
assess emotional responses lo illness. We have carried out
a study of psychornetric properties in a normal Spanish
population showing it as an easy and understandable scale
to be used. However. studies with illness populations have

3. not been made and the actual dimension measured with this
scale (anxiety, depression or general distress) is not elear.
Our aim is to study the psychometric properties of the
HAD scale in Spanish cancer patients. Ve are trying to
find out: fs this a reliable and a valid instrument to be used
with Spanish cancer patients?; What are the constructs the
scale assesses and could the HAO be used to discriminate
between anxiety and depression responses? What are the
sensibility and specificity to measure psychopathological
status?; and does it discriminate emotional changes related
to cancer disease phases?
Breast, Lung and Colon cancer in· and outpatients are
being selected in several disease phases (diagnostic,
treatment and follow-up) to complete an open-ended inter-
view using the HAn scale, the Zung Depression Inven-
tory, the STAI and a structured interview to identify psy-
chiatric disorders based on DSM-IV criteria. Al! patients
will complete HAD scale and its self-administered form
will be evaluated. A subgroup of patients wiII also com-
plete the other anxiety and depression instruments to
know how well HAD scale correlates with these measures.
A second subgroup wiII be assessed in a blind way to
detennine psychiatric status. Therefore, a third subgroup
will be interviewed in several disease steps to establish
HAD ability to discriminate emotional chan~es.
Preliminary findings of researching patients will be avail-
able and a Iiterature review on results, conceptual and
methodological problems using HAO scale with cancer
patient settings will be presented.
Evaluation of QoL and analysis of personality by
Egogram in lung cancer patlents
T. Tsuya, T. Olume, M. Kanehara, K. Shiomi, T. Tomihara
Department 01 Pulmonary Diseases, Chugoku Rosai
General Hospital, Hiroslzima, Japan
GeneralIy, no consensus has been reached in Japan to
inform the patient that he has cancer, but provision of the
true diagnosis is necessary in securing inforrned consent.
Lung cancer patients provided the troe diagnosis in our
support system wece studied from the psyehosomatic
viewpoint.
Our support system for cancer patients and their families
composed of "Meeting for quality of tife (QoL)" was initi-
ated in December 1993. This meeting is composed of our
staff. patients, family members, and volunteers. It was
held 12 times until September 1995. The number of pa-
tients present at each meeting Vas 14 with presence of 12
family members of the patients. Ve conduct on the pa-
tients Egogram check list and QoL self-assessment que-
stionnaire (The Japanese Society for Cancer Therapy)
concerning four categories of physical symptoms, physi-
cal functioning, psyehological well-being, and social
functioning. The changes in QoL and Egograms of 26
patients before and after their participation Vere evalu·
ated.
Examination by category of the cases whose mean QoL
score was elevated showed physical functioning in 12
cases (46%), physical symptoms in 10 ca¡es (38%), psy-
chological well-being in 11 cases (42%) and social func-
tioning in 15 cases (58%). In the group showing decrease
in physical functioning and social functioning of QoL
score, AC (adapted child) value of Egogram was signifi-
cantly elevated when compared to the groups with eleva-
tion of each category. In the group showing decrease in
psychological well~being seore, CP (critical parent) value
was significantly decreased.
The usefulness of Egogram was suggested for the elevation
and maintenance of QoL.
Palliative laser endoscopic disobstruction for
tracheobronchial obstructlons by non resectable or
recurrent lung cancer: an evaluation of Its impact
on the quality of Iife
G. Astaral
• R. Versaci, G. Pusceddll. M. Ulargiu.J.
P. Aresl/, G. Mancal
, D. Piras2, F. Corda2
, M. Pisan02,
G. Malltova1li1
IDept. of Medical Ollcology, University 01 Cagliari,
Cagliari, ltaly,' 2TIzoracic Surgery Divo' J 1st Pnewllology
Div.; .JAnestlzesiology Div., "R. Binaglzi" Hospital,
Cagliari, ltaly
From May 1994 to June 97. 181 laser tracheobronchial
disobstructions (LDs) where carried out at the Respiratory
Endoscopy Service, "R. Binaghi" Hospital, Cagliari.
When filling in the informed eonsent form for the proce-
dure, the patient (pt) was asked his permission to evaluate
also his QL. The questionnaire used Vas the QLQ~C30
validated by the EORTC as a measure of QL in pIS wilh
lung cancer. One-hundred and fifteen pts with primary lung
cancer (MIF IOOfl5, mean age 62.7163.7, range 42-
82/47-74; 95 NSCLC, 14 SCLC and 6 unspecified) entered
the sludy; 91 were evaluable and 24 who refused at any
tiI1}e to fill in the questionnaire were excluded from the
study. The QL was evaluated al time 11 (3 days before LO),
12 (7 days afler LD) and 13 (1 month afler LO). One-hundred
and thirty-one LDs were performed on 91 evaluable pts
(mean 1.44/pt): 91 (69.5%) LOs for primary and 40
(30.5%) for recurrenl obstruclions. In 24 cases (18.4%)
only trachea was affected, in 27 (20.6%) both trachea and
bronchi, in 59 (45.0%) only bronchi (23 left and 36 right)
and in 21 (16.0%) the ¡ocation of obstruction was not
specified. One-hundred and seven (81.7%) ECOG PS 3-4
were found at tI, 13 (9.9%) at t2 and 9 (6.9%) al 13. One-
hundred and twelve (85.5%) C30 scores _57 (high dis-
tress) were found al tI, 26 (19.8%) at t2 and 24 (18.3%) at
t3, whereas 41 (31.3%) C30 scores _90 (very high dis-
tress) were found at ti, I al t2 (0.8%) and O al t3. Statisti-
cal analysis (e2. el. 95%) indieates that LD enables a
marked improvemenl of lhe ECOG PS (3-4 vs 0-2: 11 vs 12
p= 0.000, C.I. 95%: 0.63/0.80; 11 vs 13 0.000,
0.67/0.83) and of the QL (C30 scores _57: tI vs 12 0.000,
0.57/0.75; tI vs 13 0.000, 0.58/0.76; C30 scores 30: ti
vs t2 0.000, 0.22/0.39; tI vs t3 0.000, 0.23/0.39) of pts
with respiratory obstruction which is maintained for at
least I month. Therefore. LD must be considered an effec-
tive palliative trealment both for objeclive (ECOG PS) and
subjeclive (QL) symptoms.
York supported by C.N.R., Rome, A.P. "A.C.R.O.",
Contr. 96.00588.PF39.